Review Question - QID 216472

A 3-week-old infant, born at 34 weeks gestation, is brought to the emergency department for lethargy. His parents state that he has been difficult to arouse over the past hour and now barely wakes up at all. The child has not received any vaccinations due to parental preference, but he was given oral vitamin K shortly after birth. The infant's vitals are within normal limits for his age. Physical exam reveals a lethargic infant who is difficult to arouse and a tense fontanelle. The infant appears to become progressively more lethargic in the emergency department. There are no bruises present, the oral cavity is unremarkable, and the infant moves all extremities. An ophthalmoscopic exam demonstrates mild papilledema. Which of the following is the most likely underlying pathophysiology of this patient’s presentation?